Remediation Methods for Milestones Related to Interpersonal and Communication Skills and Professionalism

摘要

Editor's Note: The online version of this article contains vignettes in emergency medicine, family medicine, obstetrics and gynecology, and psychiatry, as well as remediation approaches by proficiency level for Emergency Medicine Interpersonal and Communication Skills and Professionalism Milestones.;The Problem Despite the importance of professionalism and ICS to the training of future physicians, residency programs often struggle with educating residents in these areas, as well as providing effective remediation for those who fail to meet expectations.5–7 In a survey, pediatrics program directors reported that residents terminated after failed remediation were significantly more likely to have deficiencies in ICS and professionalism,8 while neurology program directors noted that the most prevalent issue for “problem neurology residents” was professionalism, as demonstrated by inappropriate interactions with colleagues and staff.9 Among program directors in emergency medicine, 80% noted that deficiencies in professionalism were harder to remediate than deficiencies in other core competencies.10 Clinical skills examination scores for Canadian medical students showed a predictive relationship between students who scored poorly on communication and future complaints in their medical practice, with students in the bottom quartile accounting for a significantly higher percentage of patient complaints.11 Program directors face multiple challenges in striving to effect successful remediation of residents failing to meet milestone achievements.12 While some specialties (such as emergency medicine, radiology, pathology, and ophthalmology)1,3 list suggested assessment methods for the competencies, many provide no guidance to program directors with regard to how to assess trainees in their progression on milestone achievements, and there are few specific recommendations for remediation when residents fail to meet expectations. While the Milestone Project provides programs with concrete achievements that residents must meet for each core competency and may aid programs in identifying residents who are not meeting expectations,1–4,27–29 the transition from identification to remediation requires knowledge of available resources and expertise in remediation and evaluating outcomes of remediation.30–34;A Remediation Task Force Was Born A remediation task force was developed for the Council of Residency Directors in Emergency Medicine (CORD-EM) and was charged with developing activities and tools to assist programs with remediation of residents regarding each proficiency level specific to each subcompetency. Our group focused on professionalism and ICS; each member completed an independent literature review regarding methods to remediate professionalism and ICS, and collated relevant literature from all medical specialties. Participants suggested specific methods to address remediation based on (1) a literature review, and (2) previous experience with remediation in professionalism and ICS. When approaching proficiency levels within professionalism and ICS, the group agreed to focus the assessment on levels 1 through 4, as level 5 represented aspirational achievements that may not be achieved during training, and thus did not require remediation. Consensus was obtained on specific methods to address substandard performance for proficiency levels 1 through 4 in each of the emergency medicine subcompetencies (references were used where available and are provided as online supplemental material).;Core Programs' Common Themes Identified for ICS and Professionalism As the task force work was completed, it became clear that our approach could be easily translated across graduate medical education programs. We then reviewed the subcompetencies for professionalism and ICS for the specialties of anesthesiology, diagnostic radiology, emergency medicine, family medicine, internal medicine, pathology, pediatrics, psychiatry, obstetrics and gynecology, oph